Provider Demographics
NPI:1225102692
Name:SPARROW, ROBERT J (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:SPARROW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1476
Mailing Address - Street 2:
Mailing Address - City:IDAHO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80452-1476
Mailing Address - Country:US
Mailing Address - Phone:303-567-9211
Mailing Address - Fax:303-567-9212
Practice Address - Street 1:1800 COLORADO BLVD.
Practice Address - Street 2:SUITE 8
Practice Address - City:IDAHO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80452-1476
Practice Address - Country:US
Practice Address - Phone:303-567-9211
Practice Address - Fax:303-567-9212
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC17583Medicare UPIN